Choosing An Antidepressant That’s Right For You

I was started on Paxil and took it for approximately six months. I thought it was working, but when I went to my counseling session, I was switched to Prozac. How or what determines which medication is effective? Are patients the last to know what is helping and what is not? Why does one antidepressant work when another doesn’t?

We think of depression as a matter of feeling down and having morbid thoughts, so you would expect the patient to be quite aware of any improvement. But, oddly enough, patients may be the “last” to know (to exaggerate a bit) whether an antidepressant is working.

This is because improvement may first occur in areas of behavior and demeanor — more energetic activity, brighter expression, better functioning — and be observed by others while the patient is still feeling low; in other words, you’re objectively better but subjectively the same.

However, in your case, you thought Paxil was working. More to the point, it seems that you are out of the decision-making loop about your condition and your treatment. The doctor decides, and you are “switched.” You are the passive recipient of these decisions.

But this is wrong! Participate in your own care. As a free individual, you can give or withhold “informed consent” to any treatment. You are not a sack of potatoes. Ask your doctor to explain and discuss his or her recommendations.